Federal Mental Health Agency to Drop DSM Use

The National Institute of Mental Health is moving away from the Diagnostic and Statistical Manual of Mental Disorders, sometimes known as the psychiatrist's "bible," saying that patients deserve better.

The change won't alter the way patients get diagnosed and treated in the clinic — at least not for many years. Instead, researchers seeking to study mental disorders with National Institute of Mental Health (NIMH) funding will be required to look at patients across traditional diagnoses, rather than limiting their studies to a single DSM diagnosis such as depression, for example.

"Studies of biomarkers for 'depression' might begin by looking across many disorders with anhedonia or emotional appraisal bias or psychomotor retardation to understand the circuitry underlying these symptoms," NIMH director Thomas Insel wrote in a statement.

The DSM's fifth revision, the DSM-5, is due out in May. The book, published by the American Psychiatric Association, classifies mental disorders, and the revisions have spurred controversy. Particular disorders, such as sexual fetishes, are contested by those who would like to see them removed from the book and those who would like to see those diagnoses remain available.

Compared with the NIMH's shift, however, the DSM changes are minor. The agency is looking to improve the way mental disorders are identified in general.

"Unlike our definitions of ischemic heart disease, lymphoma or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure," Insel wrote.

As an alternative, the NIMH is launching the Research Domain Criteria Project. The goal, according to the agency, is "to transform diagnosis by incorporating genetics, imaging, cognitive science and other levels of information to lay the foundation for a new classification system."

The decade-long project will require researchers to include patients across DSM categories, or to subdivide the categories, when conducting research trials.

"We need to begin collecting the genetic, imaging, physiologic and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response," Insel wrote.

The agency acknowledged that such a shift will be a challenge in a time of limited funding and budget cuts, but said that patients should welcome the step toward better diagnosis and understanding of mental disorders.